SERVICE REGISTRATION – SUPRASEED Technologies LLC

Service *

In Shop (walk-in, bring-in, or mail in)
Onsite (go where service is needed)
Remote (over a phone or internet)
Mixture

Will this service be performed in our shop, onsite, remotely, or a mixture of those?

Is this for an Individual or an Organization? *

Individual
Organization

Who is responsible for the bill?

Are you a returning customer? *

Yes
No

Are you in our system?

Do you agree and consent to the storage of the information entered in this form? *

Yes, I Agree and Consent
No, I do NOT Agree nor Consent

We will not sell or share your information. If you do not agree then this registration process STOPS HERE and you must contact us to proceed (go back to the home page and click Contact Us)

Name *

Please provide the name of the organization that would be on the account

Contact Name

First

Last

Please provide the first and last name of the person we will be communicating with for this service

Name *

First

Last

Please provide the first and last name of the person that would be on the account

Phone Number *

Please provide the phone number that would be on the account

Contact Phone Number

Please provide the contact phone number for the person listed as a contact for this service

Email *

Email

Confirm Email

IMPORTANT: Please CONFIRM and VERIFY that this email would be on the account

Contact Email (if needed)

Email

Confirm Email

IMPORTANT: Please CONFIRM and VERIFY that this email is the correct CONTACT email for this service

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Please provide the mailing address that will be on the account used for billing and contact purposes

Location Address *

Address Line 1

Address Line 2

City

State

Zip Code

Please provide the address where any onsite services will be performed

Do you wish to be contacted by us after this registration? *

Yes
No

We can call or text you upon registration if you require

When needed which method do you prefer we to contact you? *

Phone (to the contact phone number provided)
Text (to the contact phone number provided that can receive SMS text messages)
Email (to the email provided)

Servicing Equipment or Media?

Yes
No

Are we going to be servicing any equipment or media as a part of this service?

Equipment Type *

Equipment Brand *

Operating System(s) *

Please select the Operating System(s) or OS(es) that is installed and running on the equipment

Model Series (e.g. Inspiron, iMac 27inch 2015, iPhone 12, Galaxy S20, VHS or DVD) *

Please enter the model of the equipment or media to be serviced or enter "unknown" if not known.

Serial Number (or any unique manufacturer number or code on the equipment) *

Please enter any serial numbers of the equipment to be serviced separated by commas (usually a long code located on the bottom or in the "About" info and preceded by "SN" or "Serial") - if there is nothing like this on the equipment anywhere then type something UNIQUE and SPECIFIC about the appearance of the equipment (e.g. blue and silver with quarter inch straight scratch on top right corner near power port etc.)

Please Slide to Select How Many Equipment Units? (10 is 10 or more)

Selected Value: 1

Please select the number equipment units being registered as a target for service. (Desktop, Laptop, Phone, Drives/Disks for Data recovery, etc.)

Warranty *

None
OEM (manufacturer)
SUPRASEED

Please select the warranty status of the device if known (we do not provide OEM warranty services so we will let you know if warranty service is required by an OEM warranty service provider after equipment inspection)

AC Adapter Included *

Yes
No

Please select if you will provide an AC Power Adapter for the equipment

How will you provide the Device PIN code or Password? *

Entered in the boxes below
Will provide on drop-off or arrival
Will provide over Phone or Text later

Please select if you can provide the PIN code or Password for the device now, on arrival, or at a later time over the phone of text message

Temporary Device PIN code or Password

Password

Confirm Password

We recommend that you set a temporary admin password and/or PIN on the equipment before the equipment is serviced and enter that temporary PIN code or admin Password here.

Do you wish to provide another Device PIN code or Password? *

Yes
No

Secondary Temporary Device PIN code or Password

Password

Confirm Password

We recommend that you set a temporary admin password and/or PIN on the equipment before the equipment is serviced and enter that temporary PIN code or admin Password here.

Date and Time of Arrival *

Date

Time

Please provide the Date and Time of the equipment arrival to our drop-off location. (if mailed then estimate based on shipping)

Service Details & Error Messages (if it's equipment include the symptoms) *

Please provide any details you can for the reason of this service registration or any extra information we may need, including extra contact info, etc.

File Upload (click the box and select files or drag and drop files into the box)

Click or drag files to this area to upload. You can upload up to 10 files.

Please upload any files that may help with this service (i.e. documents, pictures, screenshots, notes etc.)

*

By selecting this box you agree that SUPRASEED Technologies LLC is NOT liable for File and/or Data loss of any kind

(We highly recommend performing a backup of your important files and data (if possible) before having the equipment serviced. When your equipment is in our possession we will always attempt to preserve your files and/or data but you may incur extra charges for this service)

Signature

By signing this form you herby agree that all information and selections you have provided on this form is accurate and correct. (you may sign with your finger or any object that will work on your device)